What this guide is best for
Direct answer: Use this guide when you need one clear comparison or caution explained before you contact anyone.
Best used when: A city or state page is too broad and you need one cleaner decision path.
Quick answer
No public source says whether your plan covers testosterone therapy. Coverage sits in your own plan documents, and those are not published anywhere you can compare them.
One payer's prices are public. Medicare publishes, per billing code, what clinicians charged, what it allowed and what it paid. That file will not tell you what your insurer will do, but it does tell you which pieces of a hormone programme are billable services with a published price and which pieces are not billable at all.
That distinction is the useful one. If a component has no billing code, no insurer is paying for it and the whole cost is yours.
The billable components, and what Medicare did with them in 2024
National figures, office setting, calendar year 2024.
| Code | What it covers | Clinicians who billed it | Average submitted charge | Average Medicare allowed | Average Medicare paid |
|---|---|---|---|---|---|
| 84403 | Total testosterone | 11,998 | $148.21 | $25.19 | $25.19 |
| 84402 | Free testosterone | 1,870 | $170.57 | $24.87 | $24.87 |
| 82670 | Total estradiol | 4,484 | $160.59 | $27.30 | $27.30 |
| 84443 | Thyroid stimulating hormone | 32,960 | $95.90 | $16.44 | $16.44 |
| 85025 | Complete blood count | 54,652 | $37.12 | $7.59 | $7.59 |
| 80053 | Comprehensive metabolic panel | 45,390 | $61.45 | $10.33 | $10.33 |
| 96372 | Injection under the skin or into muscle | 215,456 | $55.33 | $13.42 | $9.79 |
| 11980 | Hormone pellet placement under the skin | 2,039 | $274.77 | $86.79 | $64.92 |
Every one of these rows exists because Medicare received claims for that code and allowed them. That is a fact about the code, not a promise about your treatment or your plan.
The column most people skip, and what it shows
Compare the last two columns. On the six laboratory codes the amount Medicare paid is identical to the amount it allowed: $25.19 and $25.19 on total testosterone, $7.59 and $7.59 on the blood count.
On the two procedure codes it is not. Medicare allowed $13.42 for an injection and paid $9.79. It allowed $86.79 for pellet placement and paid $64.92.
The two columns are not the same measurement. The allowed amount includes the beneficiary's coinsurance; the payment column is what Medicare itself paid. So on those two rows the difference between the columns is the patient's share, and on the laboratory rows there is no patient share left to show.
This is worth carrying into a conversation with any insurer. "Is it covered" is the wrong question. "What is allowed, what does the plan pay, and what is left for me" is three questions, and only the third one is your bill.
What is not in this file at all
The medication is not here. This dataset covers services clinicians bill, not drugs dispensed by a pharmacy, so no hormone product appears in it at any price.
The clinic's monthly programme fee is not here either, and it is not published anywhere else. It is not a billing code. It is a price a business sets.
Compounded preparations are outside public data twice over. The FDA states that "Compounded drugs are not FDA-approved" and that it "does not verify the safety, effectiveness or quality of compounded drugs before they are marketed". A product in that category has neither a published price nor an FDA review behind it, which is worth knowing before you assume an insurer will treat it like any other prescription.
What to ask, and who to ask
Ask the clinic:
- Do you bill insurance at all, or are you cash-pay only?
- Which billing codes will appear on the claim for my labs and for my visits?
- Is the medication billed through my pharmacy benefit or sold by you directly?
- Is what you are prescribing an FDA-approved product or a compounded preparation?
- Which parts of the monthly fee are never billable to any insurer?
Then ask your insurer, using those codes rather than the word "TRT":
- Is this code covered under my plan, and does it need prior authorisation?
- What is the allowed amount, and what is my share of it?
- Does the answer change if the clinic is out of network?
- How many times a year is the lab code covered?
Common mistake: asking an insurer whether it covers testosterone therapy. Insurers adjudicate codes, not treatment names, and the answer to the general question is rarely the answer to your claim.
Red flags
A clinic that will not name the codes it bills. A promise that "insurance usually covers it" with nothing in writing. A prepaid annual package sold before anyone has checked a single code against your plan. A quoted lab panel value that collapses when you hold it against the table above.
Where these numbers come from, and what they are not
Source: Centers for Medicare & Medicaid Services, Medicare Physician & Other Practitioners — by Geography and Service, calendar year 2024 claims (file released 21 May 2026).
Method: we pull the published rows for each billing code in the office place of service, keep the average submitted charge, the average Medicare allowed amount and the average Medicare payment, and print them unchanged. Nothing is modelled, averaged across codes, or adjusted.
- The submitted charge is what clinicians billed. It is list price. Almost nobody pays it.
- The allowed amount is what Medicare permitted, including the patient's coinsurance. It is a negotiated price.
- The Medicare payment is what the programme itself paid. Where it is lower than the allowed amount, the remainder is the beneficiary's share.
- These are Medicare fee-for-service claims. The patients skew 65 and older.
- If you are paying cash or using commercial insurance, none of these figures is your price. Use the gap between them as a bargaining range, not a quote.
- CMS hides any cell covering fewer than 11 patients, so some states are missing. We print "not published" there rather than guessing.
Common mistake: reading the allowed amount as "the real price" and expecting a clinic to match it. It is what one payer pays one set of clinicians.
What to do next
Get the billing codes from the clinic in writing, then run them past your plan one at a time before you pay for anything.
Educational only. Not medical advice. No endorsements or rankings.